Core contradictions drive ACA criticism

US President Barack Obama pauses while speaking at Temple Emanu-El November 6, 2013 in Dallas, Texas.

BRENDAN SMIALOWSKI/afp/getty

As the Affordable Care Act continues to find its footing and the system grows stronger, its detractors are finding that their arguments are running into each other in unhelpful ways.

For example, for years, Republicans have argued that “Obamacare” redistributes wealth in such a way as to punish the wealthy. The party stuck to that line, right up until Sen. Ted Cruz (R-Texas) argued the exact opposite: ”[Obamacare] exacerbates income inequality. This is why the rich have gotten richer under President Obama.”

You can say the ACA goes too far to help the poor, or the ACA goes too far to help the rich, but you shouldn’t say both at the same time.

The same is true of enrollment numbers – critics of the law tend to complain that enrollment totals to date are both too high and too low.

Likewise, the right has long believed the health care law goes too far to help bring coverage to the uninsured. Now, however, some conservatives are arguing it doesn’t go far enough. Consider Charles Krauthammer’s take last night on Fox News:

“[Y]ou get this crazy paradox where the CBO, the Congressional Budget Office, has projected that the number of uninsured Americans in 10 years will be 31 million.

“When Obama launched Obamacare in 2009, he explained the moral imperative was because there were 30 million uninsured Americans. So here we’re going to go through a complete revolution of one-sixth of the U.S. economy, the dislocation of doctors, hospitals, patients, and plans everywhere, including insurers, in order to achieve a result in a decade where we have essentially the same number of uninsured. So what was this all about?”

The problem, of course, isn’t just the rhetorical contradiction. More to the point, these ACA critics are simply wrong.

Part of the trouble seems to be some confusion over that the Congressional Budget Office actually said. Jonathan Cohn had a good piece on this last week.

CBO actually starts with a much higher baseline for the number of uninsured – 57 million non-elderly Americans – because of the data it uses. (Estimates of the uninsured vary a lot depending on which survey you choose and how you define the term.) And the Affordable Care Act, according to CBO, will reduce that number significantly. Without the law, CBO says, the number of uninsured Americans would stay at roughly 57 million. But thanks to the various coverage expansions – not just the creation of new private insurance marketplaces, but also the expansion of Medicaid and ability of young adults to stay on their parents’ plans – the number of uninsured will decline markedly.

By 2017, according to CBO, Obamacare will have reduced the number of Americans without insurance by nearly half – or more, if you don’t count undocumented workers.

What’s more, the number of uninsured Americans will be even lower still if more “red” states embraced Medicaid expansion, but conservative opponents of the law don’t want that to happen, either.

Given this, it’s hard to understand what in the world Krauthammer was even trying to say. He told a national television audience that the CBO found that the nation will “have essentially the same number of uninsured” in the near future as we did in 2009. That’s plainly, demonstrably wrong – it’s not what the CBO said and it’s not consistent with any projections from any source.

If conservative critics of the law want to argue that expanding coverage isn’t a worthwhile goal, that’s fine. If they believe there are better ways to reach that goal, that’s fine, too.

But they can’t – or at least, shouldn’t – argue that the law will make no difference in reducing the number of uninsured Americans. Reality shows otherwise.